Pharmaceutical compositions

ABSTRACT

Pharmaceutical compositions are provided which comprise effective amounts of an analgesic to treat a subject, including to reduce or eliminate an adverse effect associated with the analgesic.

CROSS-REFERENCE

This application is a continuation of U.S. application Ser. No.14/099,432, filed Dec. 6, 2013, which is a continuation of U.S.application Ser. No. 12/444,521, a national stage entry ofPCT/US2007/080831 filed Oct. 9, 2007, now U.S. Pat. No. 8,653,066, whichclaims the benefit of U.S. Provisional Applications No. 60/850,451 filedOct. 9, 2006, 60/921,563 filed Apr. 3, 2007, and 60/948,375 filed Jul.6, 2007, all of which are incorporated herein by reference in theirentirety.

BACKGROUND OF THE INVENTION

Available pain medications may have adverse effects such as nausea,vomiting, and skin rashes. While such medications may be effective inproviding pain relief, many subjects are unable to tolerate recommendeddosages needed for effective pain relief because of adverse effects.Accordingly, there remains a need for effective analgesics with reducedadverse effects within the art of analgesic compositions.

SUMMARY OF THE INVENTION

In general the invention comprises methods and compositions designed totreat a subject with a drug formulation comprising multiple activeagents.

In one aspect of the invention a composition comprises, an opioidanalgesic, a non-opioid analgesic agent, an agent that reduces oreliminates an adverse effect of an opioid analgesic agent and apharmaceutically acceptable carrier or vehicle.

The invention also relates to methods for treating pain comprisesadministering to a subject in need thereof an effective amount of anopioid analgesic agent, a non-opioid analgesic agent and an agent thatreduces or eliminates an adverse effect of an opioid analgesic agent.For example, the agent which reduces adverse effects is an anti-emeticagent or antihistamine.

The invention further relates to pharmaceutical compositions comprisingfrom 1% to 20% by weight of an antihistamine; from 10% to 80% by weighta non-opioid analgesic; and from 1% to 20% by weight of an opioidanalgesic. In a further aspect, a pharmaceutical composition comprisesan opioid analgesic, a non-opioid analgesic and an antihistamine,wherein the relative ratio of said opioid analgesic, said non-opioidanalgesic and said antihistamine is from 1 to 2:40 to 45:1 to 2respectively.

The invention also relates to, pharmaceutical compositions comprising anopioid analgesic, a non-opioid analgesic and an antihistamine, which isdesigned to provide a plasma concentration of said antihistamine at asubstantially greater rate than said opioid and said non-opioidanalgesic.

In another aspect of the invention, disclosed herein is a method oftreating a subject to alleviate any condition which could benefit fromadministering an effective amount of a pharmaceutical compositioncomprising an opioid analgesic, a non-opioid analgesic and anantihistamine. In one embodiment, the condition is an adverse effectassociated with administration of an opioid analgesic.

The invention further relates to methods for treating a subjectsuffering from or susceptible to pain, comprises administering to saidsubject a pharmaceutical composition comprising an effective amount of afirst component which is a non-opioid analgesic, or a pharmaceuticallyacceptable salt thereof; a second component which is a non-opioidanalgesic, or a pharmaceutically acceptable salt thereof; and aneffective amount of a third component which is an antihistamine.

INCORPORATION BY REFERENCE

All publications and patent applications mentioned in this specificationare herein incorporated by reference to the same extent as if eachindividual publication or patent application was specifically andindividually indicated to be incorporated by reference.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates the chemical structure of hydrocodone bitartrate. Itis an opioid analgesic and antitussive and occurs as fine, whitecrystals or as a crystalline powder. The chemical name is:4,5α-epoxy-3-methoxy-17-methylmorphinan-6-one tartrate (1:1) hydrate(2:5). The chemical formula is C₁₈H₂₁NO₃.C₄H₆O₆.2½ H₂O; M.W.=494.50.

FIG. 2 illustrates the chemical structure of oxycodone hydrochloride.

FIG. 3 illustrates the chemical structure of acetaminophen,4′-hydroxyacetanilide. It is a slightly bitter, white odorless,crystalline powder, and a non-opioid, non-salicylate analgesic andantipyretic. The chemical formula is C₈H₉NO₂; M.W.=151.16.

FIG. 4 illustrates the chemical structure of promethazine.

DETAILED DESCRIPTION OF THE INVENTION

The present invention is generally directed to compositions comprisingof multiple active agents that are useful as therapeutics thatalleviate, abate or eliminate an adverse effect associated with opioidand/or non-opioid analgesic agents. In various embodiments of theinvention a composition comprises an effective amount of two actives, aneffective amount of three active agents, an effective amount of fouractive agents, an effective amount of five active agents or more thanfive active agents. An active agent is selected from various classes ofdrugs, including but not limited to opioid analgesics, non-opioidanalgesics, decongestant, expectorant, mucus thinning drugs,antitussives, antihistamines or a combination thereof.

Various aspects of the invention are directed to compositions comprisingan analgesic (e.g., one analgesic or two, three or more analgesics) andan adverse-effect-reducing active agent (e.g., an antihistamine orantiemetic). Such analgesics can include one or more opioid analgesics,or one or more non-opioid analgesics. In various further embodiments thecompositions comprise an antihistamine, or an antiemetic.

In one aspect, a pharmaceutical composition is provided comprising, aneffective amount of an opioid analgesic, an effective amount ofnon-opioid analgesic agent, and an effective amount of an agent thatreduces or eliminates an adverse effect of said analgesic agents. In oneembodiment, the agent that reduces or eliminates an adverse effect is anantiemetic agent or antihistamine. In further embodiments, the adverseeffect reduced or eliminated is associated with an opioid analgesic. Inone embodiment, the adverse effect is associated with a non-opioidanalgesic.

In some embodiments, the agent which reduces or eliminates a adverseeffect of an opioid analgesic agent is promethazine, dolasetron,granisetron, ondansetron, tropisetron, palonosetron, domperidone,droperidol, haloperidol, chlorpromazine, prochloperazine,metoclopramide, alizapride, cyclizine, diphenhydramine, dimenhydrinate,meclizine, hydroxyzine, cannabis, dronabinol, nabilone, midazolam,lorazepam, hyoscine, dexamethasone, trimethobenzamide, emetrol andpropofol.

In one embodiment, a composition of the invention comprises a non-opioidanalgesic agent which is acetaminophen or ibuprofen.

In one embodiment, the opioid analgesic agent is hydrocodone oroxycodone, or a pharmaceutically acceptable salt, thiosemicarbazone,p-nitrophenylhydrazone, o-methyloxime, semicarbazone, orbis(methylcarbamate) (each of the foregoing being an opioid analgesicagent or derivative). In a further embodiment, the opioid analgesicagent is hydrocodone bitartrate or oxycodone hydrochloride.

In one aspect of the invention, the pharmaceutical composition is in theform of a multi-layered tablet, such as in the form of a bi-layeredtablet. In one embodiment, the bi-layered tablet comprises: (a) aninner, immediate-release layer that comprises the agent that reduces oreliminates an adverse effect of an opioid analgesic; and (b) an outer,controlled-release layer that comprises the agent that reduces oreliminates an adverse effect of an opioid analgesic, the opioidanalgesic agent and the non-opioid analgesic agent.

In one embodiment, a pharmaceutical composition is provided comprisingan opioid analgesic, a non-opioid analgesic and an antihistamine,wherein said composition is capable of providing a plasma concentrationof said antihistamine at a substantially sooner than plasmaconcentrations of said opioid and said non-opioid analgesic are achievedpost administration. For example, a pharmaceutical compositioncomprising three active agents—opioid analgesic, non-opioid analgesic,and antihistamine or antiemetic—will provide a plasma concentration ofthe latter antihistamine or antiemetic at about 1 to about 20 minutes,which is substantially faster than providing the an analgesic, which canbe provided in about 30 minutes to about 12 hours.

In various embodiments, a pharmaceutical composition is providedcomprising from 1% to 20% by weight of an antihistamine; from 10% to 80%by weight a non-opioid analgesic; and from 1% to 20% by weight of anopioid analgesic.

In one embodiment, the composition is capable of increasing a plasmaconcentration of said antihistamine in about 1 minute to about 20minutes after administration to a subject.

In some embodiments, the antihistamine is selected from a groupconsisting of promethazine, dolasetron, granisetron, ondansetron,tropisetron, palonosetron, domperidone, droperidol, haloperidol,chlorpromazine, prochloperazine, metoclopramide, alizapride, cyclizine,diphenhydramine, dimenhydrinate, meclizine, hydroxyzine, cannabis,dronabinol, nabilone, midazolam, lorazepam, hyoscine, dexamethasone,trimethobenzamide, emetrol and propofol.

In one aspect of the invention, a method is provided for treating asubject in need thereof, comprising administering to a subject in needthereof an effective amount of a pharmaceutical composition comprisingan opioid analgesic agent, a non-opioid analgesic agent and an agentwhich reduces or eliminates a adverse effect of said analgesic agents.

In one embodiment, a method is provided for treating a subject sufferingfrom or susceptible to pain, comprising administering to said subject apharmaceutical composition comprising an effective amount of a firstagent which is a non-opioid analgesic, or a pharmaceutically acceptablesalt thereof; an effective amount of a second agent which is anon-opioid analgesic, or a pharmaceutically acceptable salt thereof; andan effective amount of a third agent which reduces a adverse effectassociated with said analgesics.

In some embodiments, the agent for reducing or eliminating a adverseeffect is promethazine, dolasetron, granisetron, ondansetron,tropisetron, palonosetron, domperidone, droperidol, haloperidol,chlorpromazine, prochloperazine, metoclopramide, alizapride, cyclizine,diphenhydramine, dimenhydrinate, meclizine, hydroxyzine, cannabis,dronabinol, nabilone, midazolam, lorazepam, hyoscine, dexamethasone,trimethobenzamide, emetrol or propofol.

The pharmaceutical composition can be in any form disclosed herein, suchas a multi-layered tablet (e.g., a bi-layered tablet). In oneembodiment, the multi-layered tablet is a bi-layered tablet thatcomprises: (a) an outer, immediate-release layer that comprises an agentwhich reduces or eliminates an adverse effect of an opioid analgesic;and (b) an inner, controlled release layer that comprises an opioidanalgesic agent and a non-opioid analgesic agent.

In one embodiment, the agent (e.g., promethazine) reducing oreliminating adverse effects is released at a substantially greater ratethan an opioid or non-opioid analgesic comprised in a pharmaceuticalcomposition of the invention, as further described herein. For example,a plasma concentration of the agent that reduces or eliminates anadverse effect of an opioid analgesic is achieved in about 1 minute toabout 20 minutes, as compared to an analgesic plasma concentrationprovided in about 30 minutes to about 8 hours. In various embodiments,the pharmaceutical composition of the invention comprises an agent thatreduces or eliminates an adverse effect which agent is released in atleast about 1 minute to at least about 20 minutes. In one embodiment,such an agent is an antihistamine or antiemetic. In various embodiments,such an agent is promethazine, dolasetron, granisetron, ondansetron,tropisetron, palonosetron, domperidone, droperidol, haloperidol,chlorpromazine, prochloperazine, metoclopramide, alizapride, cyclizine,diphenhydramine, dimenhydrinate, meclizine, hydroxyzine, cannabis,dronabinol, nabilone, midazolam, lorazepam, hyoscine, dexamethasone,trimethobenzamide, emetrol or propofol.

In one embodiment, a pharmaceutical composition comprises an opioidanalgesic agent, a non-opioid analgesic agent, and an agent useful forpreventing and/or suppressing an adverse effect associated with theopioid and/or non-opioid analgesic. An adverse effect of an opioidand/or non-opioid analgesic includes but is not limited to nausea,vomiting, other gastric upsets, skin rashes, allergic reactions such asswelling, difficulty breathing, closing of throat, abdominal pain,unusual bleeding or bruising and skin rashes or skin rashes. In oneembodiment, an adverse effect(s) reduced or eliminated is associatedwith an opioid analgesic including but not limited to nausea, vomiting,constipation or a combination thereof.

In a further embodiment, the opioid analgesic agent is, for example,hydrocodone, oxycodone or fentanyl; the non-opioid analgesic agent is,for example, acetaminophen, ibuprofen, ketaprofen, naproxen, or aspirin;and the agent useful for preventing and/or suppressing an adverse effectis, for example, an antihistamine such as promethazine.

In another embodiment a composition comprises an analgesic agent, anantitussive agent, and an agent useful for preventing and/or suppressingan adverse effect of the analgesic agent and/or the antitussive agent.Of course, under some circumstances an antitussive is also an analgesic.

Thus in some embodiments the composition comprises acetaminophen,hydrocodone or oxycodone; the antitussive agent is, for example,dikasetron, domperidone, meclizine, dronabinol, a benzodiazepine, ananticholinergic, hydrocodone or oxycodone; the agent useful forpreventing and/or suppressing adverse effect is, for example, anantihistamine such as promethazine.

Another embodiment of the invention is directed to a pharmaceuticalcomposition, comprising an opioid analgesic agent, a non-opioidanalgesic agent, and an antiemetic agent.

In a further embodiment of this invention, the opioid analgesic agentis, for example, hydrocodone, oxycodone; the non-opioid analgesic agentis, for example, acetaminophen, ibuprofen, ketaprofen, naproxen, oraspirin; the antiemetic agent is, for example 5-HT₃ receptorantagonists, a dopamine antagonist, an antihistamine, a cannabinoid,benzodiazepines, an anticholinergic, wherein all or less than all of thetotal amount of the antiemetic agent is formulated for immediaterelease.

Another embodiment of this invention is directed to methods for thetreatment of pain, comprising administering an effective amount of anopioid analgesic agent, a non-opioid analgesic agent and an agent usefulfor preventing and/or suppressing, reducing or eliminating a adverseeffect of the opioid analgesic agent to a subject in need thereof. Themethods allow for use of analgesics in populations at risk of adverseeffect such as nausea, vomiting, other gastric upsets, skin rashes,allergic reactions such as swelling, difficulty breathing, closing ofthroat, abdominal pain, unusual bleeding or bruising and skin rashes.The opioid analgesics include, for example, hydrocodone, hydrocodonebitartrate, pharmaceutically acceptable salts and complexes ofhydrocodone, oxycodone, oxycodone HCl, pharmaceutically acceptable saltsand complexes of oxycodone. The non-opioid analgesics include, forexample, acetaminophen, ibuprofen, ketaprofen, naproxen, or aspirin. Theagents are useful for reducing or eliminating adverse effects, such as,for example, promethazine, promethazine analogue, pharmaceuticallyacceptable salts and complexes of promethazine, or combinations of thesecompounds.

In one aspect of the invention, the pharmaceutical composition comprisesan opioid analgesic, a non-opioid analgesic and an antihistamine,wherein said composition provides a plasma concentration of saidantihistamine at a substantially greater rate than said opioid and saidnon-opioid analgesic. In one embodiment the antihistamine is formulatedfor immediate-release. In another embodiment the opioid analgesic and/orthe non-opioid analgesic is/are formulated for controlled-release. Inone embodiment the composition is capable of increasing a plasmaconcentration of said antihistamine immediately after administration toa subject. In this embodiment increased a plasma concentration of saidantihistamine occurs from about 1 minute to about 20 minutes afteradministration.

Another aspect of the invention comprises a method of treating a subjectto alleviate pain, comprising administering an effective amount of apharmaceutical composition comprising an opioid analgesic, a non-opioidanalgesic and an antihistamine. In one embodiment, the antihistamine isformulated for immediate release.

In various embodiments, a dosage form of the invention provides anincreased plasma concentration of said antihistamine occurs from about 1minute to about 20 minutes after administration, such as about 1 min, 2min, 3 min, 4 min, 5 min, 6 min, 7 min, 8 min, 9 min, 10 min, 11 min, 12min, 13 min, 14 min, 15 min, 16 min, 17 min, 18 min, 19 min, 20 min, 21min, 22 min, 23 min, 24 min, 25 min. In some embodiments, the releaserate occurs at substantially faster as compared to release rates for theanalgesic agents. Therefore, after administration to a subject, theantihistamine (e.g., promethazine, dolasetron, granisetron, ondansetron,tropisetron, palonosetron, domperidone, droperidol, haloperidol,chlorpromazine, prochloperazine, metoclopramide, alizapride, cyclizine,diphenhydramine, dimenhydrinate, meclizine, hydroxyzine, cannabis,dronabinol, nabilone, midazolam, lorazepam, hyoscine, dexamethasone,trimethobenzamide, emetrol and propofol) is released and a plasmaconcentration of an antihistamine is provided before release of theopioid and/or non-opioid analgesic.

In some embodiments, a dosage form of the invention provides a plasmaconcentration of said opioid analgesic and/or said non-opioid analgesicoccurs from about 1 hour to about 4 hours after administration, such asabout 1 hr, 1.2 hrs, 1.4 hrs, 1.6 hrs, 1.8 hrs, 2.0 hrs, 2.2 hrs, 2.4hrs, 2.6 hrs, 2.8 hrs, 3.0 hrs, 3.2 hrs, 3.4 hrs, 3.6 hrs, 3.8 hrs, 4.0hrs, 5.0 hrs, 6.0 hrs, 7.0 hrs, 8.0 hrs, 9.0 hrs, 10.0 hrs, 11.0 hrs,12.0 hrs, 13.0 hrs, 14.0 hrs, 15.0 hrs, 16.0 hrs, 17.0 hrs, 18.0 hrs,19.0 hrs, 20.0 hrs, 21.0 hrs, 22.0 hrs, 23.0 hrs, or 24.0 hrs. Infurther embodiments, the opioid or non-opioid analgesic are present fromabout 1 hour to 24 hour, 1 day to 30 days, including but not limited to1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, 12, 13, 14, 15, 16, 17, 18, 19, 20,21, 22, 23, 24, 25, 26, 27, 28, 29 or 30 days. For example,administration of dosage compositions can be effected through patchdelivery systems which are known.

Another aspect of the invention comprises a method of treating a subjectto alleviate a condition comprising administering a therapeuticallyeffective amount of a pharmaceutical composition comprising an opioidanalgesic, a non-opioid analgesic and an antihistamine. In oneembodiment, the antihistamine is formulated for immediate release.

In another embodiment, a plasma concentration of said antihistamineoccurs from about 1 minute to about 20 minutes after administration. Inan additional embodiment, a plasma concentration of an opioid analgesicand/or non-opioid analgesic is achieved from about 1 hour to about 8hours after administration.

In one embodiment subjects receiving opioid analgesics and acetaminophenconcomitantly with, antihistamines, antipsychotics, antianxiety agents,or other CNS depressants is given a reduced dosage of one or more agentsto prevent or ameliorate any additive effects, such as CNS depression.In another embodiment the dosage of one or more of the agents isadjusted according to the severity of the pain and the response of thesubject.

In subjects with terminal diseases or chronic conditions pain managementcan be of a primary concern to the subject's quality of life. In some ofthese subjects tolerance to opioid analgesics can develop with continueduse. In one embodiment, adjustments are made to the amounts or timerelease characteristics of the components in a composition, comprisingan opioid analgesic, a non-opioid analgesic and an antihistamine. Inthis embodiment the adjustments are designed to provide pain relief to asubject with tolerance to opioid analgesics. In one embodiment theamount of the opioid analgesic may be increased in the composition to beadministered to a subject. In another embodiment the time releasecharacteristics of the opioid analgesic may be adjusted so as to changethe ratio of immediate-release opioid analgesic to controlled-releaseopioid analgesic.

In one embodiment of the present invention, the pharmaceuticalcompositions comprises: hydrocodone in a dosage range of between about1.0 mg to about 15 mg or oxycodone in a dosage range of between about1.0 mg to about 200 mg; acetaminophen in a dosage range of between about200 mg to about 600 mg; and, promethazine in a dosage range of betweenabout 0.5 mg to about 60.0 mg.

In another embodiment of the present invention, the pharmaceuticalcompositions comprise about 7.5 mg of hydrocodone, about 325 mg ofacetaminophen, and about 12.5 mg of promethazine.

In another embodiment of the present invention, the pharmaceuticalcompositions comprise about 7.5 mg of oxycodone, about 325 mg ofacetaminophen, and about 12.5 mg of promethazine.

In another embodiment of the present invention, the pharmaceuticalcompositions comprise an effective amount of hydrocodone or oxycodoneHCl, an effective amount of acetaminophen, and an effective amount ofpromethazine in a single, oral pill or tablet form having dosage levelsthat can be safely doubled for combating severe pain.

In a further embodiment of the present invention, all or less than allof the total amount of the promethazine is formulated for immediaterelease into the subject's blood stream.

In a further embodiment of the present invention, all or less than allof the total amount of the hydrocodone or oxycodone is formulated forcontrolled-release into the subject's body.

In various embodiments of the present invention, the agents areformulated as oral dosage forms, inhalations, nasal sprays, patches,absorbing gels, liquids, liquid tannates, suppositories, injections,I.V. drips, other delivery methods, or a combination thereof to treatsubjects.

In another embodiment of the present invention, the agents areformulated as single oral dosage forms such as tablets, capsules,cachets, soft gelatin capsules, hard gelatin capsules, extended releasecapsules, tannate tablets, oral disintegrating tablets, multi-layertablets, beads, liquids, oral suspensions, chewable lozenges, oralsolutions, oral syrups, sterile packaged powder includingpharmaceutically-acceptable excipients, other oral dosage forms, or acombination thereof.

In another embodiment of the present invention, the pharmaceuticalcompositions comprise an agent in immediate release, quick release,controlled release, sustained release, extended release, other releaseformulations or patterns, or a combination thereof.

In one aspect, a composition of the invention comprises three activeagents each of which is selected from a decongestant, an antitussive, anexpectorant, a mucus thinning drugs, an analgesic and an antihistamine.For example, in one embodiment an agent is an antitussive such as, e.g.,codeine, dihydrocodeine, hydrocodone, dextromethorphan and apharmaceutically acceptable salt thereof; another agent is adecongestant such as, e.g., phenylephrine, pseudoephedrine and apharmaceutically acceptable salt thereof, and another agent is anexpectorant. One will recognize that an active agent may fit into morethan one category (e.g., hydrocodone is an antitussive and opioidanalgesic).

In another embodiment, a composition of the invention comprises aneffective amount of an opioid analgesic (e.g., hydrocodone oroxycodone), a non-opioid analgesic (e.g., acetaminophen or ibuprofen),and an antihistamine (e.g., promethazine). In a further embodiment, thecomposition comprises an effective amount of hydrocodone, acetaminophenand promethazine. In yet a further embodiment, the composition comprisesan effective amount of oxycodone, acetaminophen and promethazine.

In any of the embodiments disclosed herein, a composition of theinvention can be administered using one or more different dosage formswhich are further described herein.

In other aspects of the invention, a composition of the invention isadministered in various dosage forms. For example, a compositioncomprising multiple active agents can be administered in solid, gel,patch or liquid form. Such dosage forms are further described herein.Examples of such dosage forms are known, such as tablet forms disclosedin U.S. Pat. Nos. 3,048,526, 3,108,046, 4,786,505, 4,919,939, 4,950,484;gel forms disclosed in U.S. Pat. Nos. 4,904,479, 6,482,435, 6,572,871,5,013,726; patches for delivery of pharmaceutical compositions such asdisclosed in U.S. Pat. Nos. 5,741,510, 4,624,665, 4,626,539, 4,834,978,6,469,227, 5,919,479, 6,261,595, 6,303,142, 6,341,387, 6,465,006,6,613,350, 6,780,426, 7,094,228, 6,756,053; capsule forms disclosed inU.S. Pat. Nos. 4,800,083, 4,532,126, 4,935,243, 6,258,380; liquid formsdisclosed in U.S. Pat. Nos. 4,625,494, 4,478,822, 5,610,184; or I.V.forms disclosed in U.S. Pat. Nos. 4,871,353, 4,925,444, 5,484,406; eachof which is incorporated herein by reference in its entirety.

In other aspects of the invention, a composition of the invention isadministered at various dosages and/or has various release rates (e.g.,controlled release or immediate release).

Immediate release refers to the release of an active agent substantiallyimmediately upon administration. In one embodiment, immediate releaseresults in dissolution of an agent within 1-20 minutes after enteringthe stomach. Dissolution can be of all or less than all of the activeagent. For example, dissolution of 100% of an agent (antihistamine orantiemetic) can occur in the prescribed time. Alternatively, dissolutionof less than all of the agent can occur in about 1 minute to about 20minutes (e.g., dissolution of about 70%, about 75%, about 80%, about85%, about 90%, about 91%, about 92%, about 93%, about 94%, about 95%,about 96%, about 97%, about 98%, about 99%, about 99.5% or 99.9% of anagent).

In another embodiment, immediate release occurs when there isdissolution of an agent within 1-20 minutes after administration. Inanother embodiment, immediate release results in substantially completedissolution within about 1 hour following administration.

In various embodiments, immediate release occurs when there isdissolution of an agent within 1-20 minutes after administration.Dissolution can be in a subject's stomach and/or intestine. In anotherembodiment, immediate release results in complete or less than completedissolution within about 1 hour following administration to a subject.In another embodiment, immediate release results in complete or lessthan complete dissolution within about 1 hour following rectaladministration Immediate release components can also be referred to asinstant release. When used in association with the dissolution profilesdiscussed herein, the term “immediate release” refers to wherein all orless than all of the total amount of a dosage form is dissolved. In someembodiments, immediate release is through inhalation, such thatdissolution occurs in a subject's lungs, as further described herein.Dissolution of less than all of an active includes but is not limited todissolution of about 50%, 60%, 70%, 80%, 85%, 90%, 95%, 97%, 98%, 99%,99.1%, 99.2%, 99.35, 99.4%, 99.5%, 99.6%, 99.7%, 99.8% or 99.99% of theactive.

Controlled-release, or sustained-release, refers to the release of anagent such as a drug or drug component from a composition or dosage formin which the agent is released according to a desired profile over anextended period of time. In one embodiment, controlled-release resultsin dissolution of an agent within 20-180 minutes after entering thestomach. In another embodiment, controlled-release occurs when there isdissolution of an agent within 20-180 minutes after being swallowed. Inanother embodiment, controlled-release occurs when there is dissolutionof an agent within 20-180 minutes after entering the intestine. Inanother embodiment, controlled-release results in substantially completedissolution after at least 1 hour following administration. In anotherembodiment, controlled-release results in substantially completedissolution after at least 1 hour following oral administration. Inanother embodiment, controlled-release results in substantially completedissolution after at least 1 hour following rectal administration. Forexample, controlled release compositions allow delivery of an agent to asubject over an extended period of time according to a predeterminedprofile. Such release rates can provide therapeutically effective levelsof agent for an extended period of time and thereby provide a longerperiod of pharmacologic or diagnostic response as compared withconventional rapid release dosage forms. Such longer periods of responseprovide for many inherent benefits that are not achieved with immediaterelease dosages. In using analgesics for treatments of chronic pain,controlled release formulations can be preferred over conventionalshort-acting formulations. When used in association with the dissolutionprofiles discussed herein, the term “controlled-release” refers towherein all or less than all of the total amount of a dosage form, madeaccording to the present invention, delivers an active agent over aperiod of time greater than 1 hour.

When present in a controlled-release oral dosage form, the compositionsof the present invention can be dosed at a substantially lower dailydosage level than conventional immediate release products. At comparabledaily dosage levels, the controlled release oral solid dosage forms canprovide greater in pain relief than conventional immediate releaseproducts.

Combination Formulations

Various aspects of the invention are directed to compositions comprisingan effective amount of an analgesic and an active agent that is usefulfor reducing an adverse effect associated with such one or more opioidanalgesics, and/or one or more non-opioid analgesic. Such additionalactive agents include antiemetics and antihistamines. In someembodiments, the analgesics are opioid or non-opioid analgesics (e.g.,hydrocodone or oxycodone and acetaminophen). In a further embodiment,the active agent which reduces adverse effects of such analgesics ispromethazine.

In one embodiment, a pharmaceutical composition of the invention, byreducing adverse effects associated with an opioid and/or non-opioidanalgesic allows for higher dosages for said analgesics in thepharmaceutical composition. For example, in a subject who could nototherwise tolerate a certain dosage of an opioid analgesic, apharmaceutical composition of the invention comprising an opioidanalgesic, a non-opioid analgesic and promethazine, will reduce theadverse effects (e.g. nausea, vomiting) associated with the analgesic,thus allowing for increased dosages to be administered. Furthermore,administration would be through a single composition.

In various embodiments, the analgesic agent of the multidrug compositioncomprises, an opioid analgesic such as hydrocodone, oxycodone, morphine,diamorphine, codeine, pethidine, alfentanil, buprenorphine, butorphanol,codeine, dezocine, fentanyl, hydromorphone, levomethadyl acetate,levorphanol, meperidine, methadone, morphine sulfate, nalbuphine,oxycodone, oxymorphone, pentazocine, propoxyphene, remifentanil,sufentanil, or tramadol; and an opioid an antagonists such as nalmefene,naloxone, or naltrexone. The composition can further compriseantitussives such as codeine or dextromethorphan.

In some embodiments, a composition of the invention comprises an opioidand non-opioid analgesic such as: codeine/acetaminophen,codeine/aspirin, hydrocodone/acetaminophen, hydrocodone/ibuprofen,oxycodone/acetaminophen, oxycodone/aspirin, or propoxyphene/aspirin oracetaminophen.

Therefore, in some embodiments, a composition comprises an analgesic andan active agent useful for reducing or eliminating adverse effects, suchas an antihistamine (e.g., promethazine) and/or an antiemetic, asdescribed herein.

In other embodiments the composition comprises an opioid, a non-opioidanalgesic, and an antihistamine (e.g., promethazine).

For example, in one embodiment, a composition comprises an opioid and/ornon-opioid analgesic and promethazine. In further embodiments, thecomposition further comprises an anti-emetic. In yet furtherembodiments, one or more additional adverse-effect-reducing activeagents can be administered separately (concurrently, before, after,administration of a multi-drug composition). In addition, any of thecompositions of the invention, can comprise a non-opioid analgesic or anopioid analgesics.

Examples of non-opioid analgesics useful in the compositions of theinvention include but are not limited to acetaminophen; a non-steroidalanti-inflammatory drug (NSAID) such as a salicylate (including, forexample, amoxiprin, benorilate, choline magnesium salicylate,diflunisal, faislamine, methyl salicylate, magnesium salicylate), anarylalkanoic acid (including, for example, diclofenac, aceclofenac,acemetacin, bromfenac, etodolac, indometacin, nabumetone, sulindac,tolmetin), a profen (including, for example, ibuprofen, carprofen,fenbuprofen, flubiprofen, ketaprofen, ketorolac, loxoprofen, naproxen,suprofen), an fenamic acid (including, for example mefenamic acid,meclofenamic acid), an oxicam (including, for example, piroxicam,lomoxicam, meloxicam, tenoxicam), a pyrazolidine derivative (including,for example, phenylbutazone, azapropazone, metamizole, oxyphenbutazone,sulfinprazone); and a synthetic drug having narcotic properties such astramadol.

Each agent is useful as its free base, where applicable or itspharmaceutically acceptable salt, prodrug, analog and complex.Pharmaceutically acceptable salts include bitartrate, bitartratehydrate, hydrochloride, p-toluenesulfonate, phosphate, sulfate,trifluoroacetate, bitartrate hemipentahydrate, pentafluoropropionate,hydrobromide, mucate, oleate, phosphate dibasic, phosphate monobasic,acetate trihydrate, bis(heptafuorobutyrate), bis(pentafluoropropionate), bis(pyridine carboxylate), bis(trifluoroacetate),chlorhydrate, and sulfate pentahydrate. In one embodiment the agent ishydrocodone, a pharmaceutically acceptable salt or itsthiosemicarbazone, p-nitrophenylhydrazone, o-methyloxime, semicarbazone,or bis(methylcarbamate). In another embodiment the agent is oxycodone, apharmaceutically acceptable salt or its thiosemicarbazone,p-nitrophenylhydrazone, o-methyloxime, semicarbazone, orbis(methylcarbamate). In a further embodiment the agent isacetaminophen, a pharmaceutically acceptable salt or itsthiosemicarbazone, p-nitrophenylhydrazone, o-methyloxime, semicarbazone,or bis(methylcarbamate). In another embodiment an agent is promethazine,a pharmaceutically acceptable salt or its thiosemicarbazone,p-nitrophenylhydrazone, o-methyloxime, semicarbazone, orbis(methylcarbamate).

The agent useful for treating a subject, such as by preventing oralleviating an adverse effect includes, for example, an antihistamineincluding a histamine agonist and an antagonist which is classifiedaccording to receptor subtype. H1 agonists or partial agonists include2-(m-fluorophenyl)-histamine, and H1 antagonists includechlorpheniramine, scopolamine, mepyramine, terfenadine, astemizole, andtriprolidine. Further antagonists (which may be further classified bytheir chemical structures) include the ethanolamines carbinoxamine,dimenhydrinate, diphenhydramine, and doxylamine; the ethylaminediaminespyrilamine and tripelennamine; the piperazine derivatives dydroxyzine,cyclizine, fexofenadine and meclizine; the alkylamines brompheniramineand chlorpheniramine; and miscellaneous antagonists cyproheptadine,loratadine, cetrizine. H2 agonists include dimaprit, impromidine, andamthamine; and H2 antagonists (useful in the treatment of gastric acidsecretion) include cimetidine, ranitidine, nizatidine, and famotidine;H3 agonists include R-alpha-methylhistamine, imetit, and immepip and H3antagonists include thioperamide, iodophenpropit, and clobenpropit; andH4 agonists include clobenpropit, imetit, and clozapine and H4antagonists include thioperamide. The agent useful for preventing orsuppressing a adverse effect can also include an H1 blocker, such asazelastine, brompheniramine, buclizine, carbinoxamine, cetrizine,chlorpheniramine, clemastine, cyclizine, cyproheptadine, desloratidine,dimenhydrinate, diphenhydramine, emedastine, fexofenadine, hydroxyzine,ketotifen, levocabastine, loratadine, meclizine, olopatadine,phenindamine, and promoathazine.

In various embodiments of compositions comprising two, three, four, fiveor more active agents, at least one of the active agents is anantihistamine. In a further embodiment, the antihistamine ispromethazine. In yet further embodiments, the promethazine is formulatedfor immediate release, controlled-release, delayed release or acombination thereof (e.g., some dosage amount for immediate release somedosage controlled/delayed release).

The compositions can comprise an antiemetic agent including, forexample, promethazine, dolasetron, granisetron, ondansetron,tropisetron, palonosetron, domperidone, droperidol, haloperidol,chlorpromazine, prochloperazine, metoclopramide, alizapride, cyclizine,diphenhydramine, dimenhydrinate, meclizine, hydroxyzine, cannabis,dronabinol, nabilone, midazolam, lorazepam, hyoscine, dexamethasone,trimethobenzamide, emetrol, propofol, or the like.

The composition can comprise an antitussive agent including, forexample, dextromethorphan, noscapine, ethyl morphine, codeine, camphor,menthol, theobromine, guaifenesin, or the like.

Therefore in various embodiments of the invention, a compositioncomprises at least two analgesics; and one antihistamine or antiemetic.For example, in one embodiment, a composition comprises hydrocodone,acetaminophen and promethazine. In another embodiment, a compositioncomprises oxycodone, acetaminophen and promethazine.

Administration

One aspect of the present invention provides a method for preventing anadverse effect such as nausea, vomiting, other gastric upsets, skinrashes, allergic reactions such as swelling, difficulty breathing,closing of throat, abdominal pain, unusual bleeding or bruising and skinrashes in a subject receiving or in need of opioid analgesic therapy bythe administration of acetaminophen or other non-opioid analgesic andpromethazine or other antihistamine with the chosen opioid analgesics.Accordingly, the invention provides methods for treating pain,comprising administering to a subject in need thereof an effectiveamount of an opioid analgesic agent, a non-opioid analgesic agent and anagent that reduces side affects of the opioid analgesic agent. In oneembodiment, the non-opioid analgesic agent is acetaminophen. In anotherembodiment, the agent that reduces an adverse effect is promethazine.The administration can continue for only a relatively short time in thecase of an acute condition requiring opioid therapy or for long periodsin the case of conditions requiring chronic use of opioid analgesics.The dosing of analgesics can be dependent upon the condition beingtreated, the subject's individual perception of pain and the use of theopioid on a set time schedule as a prophylactic to prevent the onset ofpain or on an as needed basis in response to perceived pain. The choiceof selecting a dosage of a composition that contains suitable amount ofpromethazine can be dependent upon the extent and severity of theadverse effects including nausea, vomiting, other gastric upsets, skinrashes, allergic reactions such as swelling, difficulty breathing,closing of throat, abdominal pain, unusual bleeding or bruising and skinrashes in a subject, upon the sensitivity to side-effect-reducingcompounds such as promethazine in a subject, upon the likelihood ofsubject losing medication by vomiting, and/or on an as needed basis inresponse to perceived adverse effects. The dosage can be assessed by aprescribing professional evaluating the subject, the condition treated,the analgesic to be used, diet and the expected duration of therapy.

In one embodiment, the present invention provides for a method fortreating a subject suffering from or susceptible to pain, comprisingadministering to said subject a pharmaceutical composition comprising aneffective amount of a first component which is a non-opioid analgesic,or a pharmaceutically acceptable salt thereof, an effective amount of asecond component which is a non-opioid analgesic, or a pharmaceuticallyacceptable salt thereof and an effective amount of a third componentwhich is an antihistamine.

In another embodiment, a method for treating a subject is providedcomprising administering a pharmaceutical composition comprising: aneffective amount of a first agent which is a non-opioid analgesic, or apharmaceutically acceptable salt thereof; an effective amount of asecond agent which is an opioid analgesic, or a pharmaceuticallyacceptable salt thereof; and an effective amount of a third componentwhich is an antihistamine. In one embodiment the at least one adverseeffect is selected from the group consisting of nausea, vomiting, othergastric upsets, skin rashes, allergic reactions such as swelling,difficulty breathing, closing of throat, abdominal pain, unusualbleeding or bruising and skin rashes. In one embodiment the non-opioidanalgesic is acetaminophen or analogue thereof. In one embodiment, theantihistamine is promethazine. In one embodiment, the opioid analgesicis hydrocodone. In another embodiment the opioid analgesic is oxycodone.

In another embodiment, the present invention provides for a method forpreventing an adverse effect such as nausea, vomiting, and a skin rashin a subject receiving or in need of opioid therapy by theadministration of acetaminophen or analogue thereof and promethazinewith the opioid analgesic. In one embodiment, the opioid analgesic ishydrocodone. In another embodiment the opioid analgesic is oxycodone. Inone embodiment, administration of a composition comprising a non-opioidanalgesic and an antihistamine enhances the reduction or elimination ofadverse effects associated with an opioid analgesic. For example,addition of promethazine and acetaminophen/ibuprofen reduces oreliminates an adverse effect associated with an opioid analgesic in asynergistic manner.

It is believed that administration of a composition of the inventionwould result in treatment of the subject which includes elimination orreduction of an adverse effect associated with analgesics (e.g.,opioids) and enhance the beneficial uses of such analgesics. Such anadverse effect can otherwise render administration of certain analgesicsintolerable, due to for example vomiting, nausea, and skin rashes.Therefore, various embodiments of the methods of the invention aredirected to target populations of subjects that are susceptible to suchan adverse effect(s), thus allowing such subjects to benefit from thepain-alleviating effects of analgesic-based pain relief, administrationof which would otherwise be intolerable.

For example, by reducing the risk of vomiting, the risk of subjectlosing the analgesics (and losing the pain-relieving beneficial effectsof analgesics) by vomiting is minimized. Furthermore, administration canbe adjusted to provide the dose of side-effect-reducing compound tomatch the subject's analgesic ingestion without separate intervention bythe health care professionals Adding one or more additional activeagents, such as promethazine, to the present compositions is believed toresult in a composition having reduced potential for abuse anddiversion.

Dosage

In various aspects a composition of the invention comprises multipleactive agents at the same or different dosages. In some embodiments, theanalgesic components may vary in dosages as further described herein,and the antihistamine or antiemetic dosage can be adjusted according tothe particular analgesics used.

For example, in various embodiments an opioid analgesic present in acomposition of the invention is at a dose of 1.0 mg to about 20 mg,including but not limited to 1.0 mg, 1.5 mg, 2.5 mg, 3.0 mg, 4.0 mg, 5.0mg, 6.0 mg, 6.5 mg, 7.0 mg, 7.5 mg, 8.0 mg, 8.5 mg, 9.0 mg, 9.5 mg,10.0, 10.5 mg, 11.0 mg, 12.0 mg, 12.5 mg, 13.0 mg, 13.5 mg, 14.0 mg,14.5 mg, 15.0 mg, 15.5 mg, 16 mg, 16.5 mg, 17 mg, 17.5 mg, 18 mg, 18.5mg, 19 mg, 19.5 mg or 20 mg.

In further embodiments for multi-drug compositions of the invention anon-opioid analgesic is present at a doses of 200 mg to about 600 mg,including but not limited to 200 mg, 225 mg, 250 mg, 275 mg, 300 mg, 325mg, 350 mg, 375 mg, 400 mg, 425 mg, 450 mg, 475 mg, 500 mg, 525 mg, 550mg, 575 mg, 600 mg.

In yet further embodiments of the invention, an antiemetic orantihistamine component of a multi-drug composition of the invention ispresent at a dose of 0.5 mg to about 60 mg of promethazine, includingbut not limited to 0.5 mg, 1.0 mg, 1.5 mg, 2.0 mg, 2.5 mg, 3.0 mg, 3.5mg, 4.0 mg, 4.5 mg, 5.0 mg, 5.5 mg, 6.0 mg, 6.5 mg, 7.0 mg, 7.5 mg, 8.0mg, 8.5 mg, 9.0 mg, 9.5 mg, 10 mg, 10.5 mg, 11 mg, 11.5 mg, 12.0 mg,12.5 mg, 13.0 mg, 13.5 mg, 14.0 mg, 14.5 mg, 15.0 mg, 15.5 mg, 16 mg,16.5 mg, 17 mg, 17.5 mg, 18 mg, 18.5 mg, 19 mg, 19.5 mg or 20 mg, 25 mg,30 mg, 35 mg, 40 mg, 45 mg, 50 mg, 55 mg or 60 mg.

In one embodiment, a composition of the invention comprises hydrocodone,a pharmaceutically acceptable salt or its thiosemicarbazone,p-nitrophenylhydrazone, o-methyloxime, semicarbazone, orbis(methylcarbamate) (each of the foregoing being a hydrocodone agent orderivative); acetaminophen; and promethazine. Furthermore, thehydrocodone agent is present in a range of about 1.0 mg to about 20 mg,including but not limited to 1.0 mg, 1.5 mg, 2.5 mg, 3.0 mg, 4.0 mg, 5.0mg, 6.0 mg, 6.5 mg, 7.0 mg, 7.5 mg, 8.0 mg, 8.5 mg, 9.0 mg, 9.5 mg,10.0, 10.5 mg, 11.0 mg, 12.0 mg, 12.5 mg, 13.0 mg, 13.5 mg, 14.0 mg,14.5 mg, 15.0 mg, 15.5 mg, 16 mg, 16.5 mg, 17 mg, 17.5 mg, 18 mg, 18.5mg, 19 mg, 19.5 mg or 20 mg. Furthermore, the acetaminophen is in arange of about 200 mg to about 600 mg, including but not limited to 200mg, 225 mg, 250 mg, 275 mg, 300 mg, 325 mg, 350 mg, 375 mg, 400 mg, 425mg, 450 mg, 475 mg, 500 mg, 525 mg, 550 mg, 575 mg, 600 mg. In addition,the promethazine is between about 0.5 mg to about 60 mg, including butnot limited to 0.5 mg, 1.0 mg, 1.5 mg, 2.0 mg, 2.5 mg, 3.0 mg, 3.5 mg,4.0 mg, 4.5 mg, 5.0 mg, 5.5 mg, 6.0 mg, 6.5 mg, 7.0 mg, 7.5 mg, 8.0 mg,8.5 mg, 9.0 mg, 9.5 mg, 10 mg, 10.5 mg, 11 mg, 11.5 mg, 12.0 mg, 12.5mg, 13.0 mg, 13.5 mg, 14.0 mg, 14.5 mg, 15.0 mg, 15.5 mg, 16 mg, 16.5mg, 17 mg, 17.5 mg, 18 mg, 18.5 mg, 19 mg, 19.5 mg or 20 mg, 25 mg, 30mg, 35 mg, 40 mg, 45 mg, 50 mg, 55 mg or 60 mg.

In various embodiments, a composition of the invention compriseshydrocodone, acetaminophen and promethazine, wherein the compositioncomprises the respective agents in a ratio of about (1 to 2): (40 to45):(1 to 2), such as about 1:40:1, 1:40:1.1, 1:40:1.2, 1:40:1.3,1:40:1.4, 1:40:1.5, 1:40:1.6, 1:40:1.7, 1:40:1.8, 1:40:1.9, 1:40:2,1.1:40:1, 1.2:40:1, 1.3:40:1, 1.4:40:1, 1.5:40:1, 1.6:40:1, 1.7:40:1,1.8:40:1, 1.9:40:1, 2:40:1, 1:41:1, 1:41:1.1, 1:41:1.2, 1:41:1.3,1:41:1.4, 1:41:1.5, 1:41:1.6, 1:41:1.7, 1:41:1.8, 1:41:1.9, 1:41:2,1.1:41:1, 1.2:41:1, 1.3:41:1, 1.4:41:1, 1.5:41:1, 1.6:41:1, 1.7:41:1,1.8:41:1, 1.9:41:1, 2:41:1, 1:42:1, 1:42:1.1, 1:42:1.2, 1:42:1.3,1:42:1.4, 1:42:1.5, 1:42:1.6, 1:42:1.7, 1:42:1.8, 1:42:1.9, 1:42:2,1.1:42:1, 1.2:42:1, 1.3:42:1, 1.4:42:1, 1.5:42:1, 1.6:42:1, 1.7:42:1,1.8:42:1, 1.9:42:1, 2:42:1, 1:43:1, 1:43:1.1, 1:43:1.2, 1:43:1.3,1:43:1.4, 1:43:1.5, 1:43:1.6, 1:43:1.7, 1:43:1.8, 1:43:1.9, 1:43:2,1.1:43:1, 1.2:43:1, 1.3:43:1, 1.4:43:1, 1.5:43:1, 1.6:43:1, 1.7:43:1,1.8:43:1, 1.9:43:1, 2:43:1, 1:43.1:1, 1:43.1:1.1, 1:43.1:1.2,1:43.1:1.3, 1:43.1:1.4, 1:43.1:1.5, 1:43.1:1.6, 1:43.1:1.7, 1:43.1:1.8,1:43.1:1.9, 1:43.1:2, 1.1:43.1:1, 1.2:43.1:1, 1.3:43.1:1, 1.4:43.1:1,1.5:43.1:1, 1.6:43.1:1, 1.7:43.1:1, 1.8:43.1:1, 1.9:43.1:1, 2:43.1:1,1:43.2:1, 1:43.2:1.1, 1:43.2:1.2, 1:43.2:1.3, 1:43.2:1.4, 1:43.2:1.5,1:43.2:1.6, 1:43.2:1.7, 1:43.2:1.8, 1:43.2:1.9, 1:43.2:2, 1.1:43.2:1,1.2:43.2:1, 1.3:43.2:1, 1.4:43.2:1, 1.5:43.2:1, 1.6:43.2:1, 1.7:43.2:1,1.8:43.2:1, 1.9:43.2:1, 2:43.2:1, 1:43.3:1, 1:43.3:1.1, 1:43.3:1.2,1:43.3:1.3, 1:43.3:1.4, 1:43.3:1.5, 1:43.3:1.6, 1:43.3:1.7, 1:43.3:1.8,1:43.3:1.9, 1:43.3:2, 1.1:43.3:1, 1.2:43.3:1, 1.3:43.3:1, 1.4:43.3:1,1.5:43.3:1, 1.6:43.3:1, 1.7:43.3:1, 1.8:43.3:1, 1.9:43.3:1, 2:43.3:1,1:43.4:1, 1:43.4:1.1, 1:43.4:1.2, 1:43.4:1.3, 1:43.4:1.4, 1:43.4:1.5,1:43.4:1.6, 1:43.4:1.7, 1:43.4:1.8, 1:43.4:1.9, 1:43.4:2, 1.1:43.4:1,1.2:43.4:1, 1.3:43.4:1, 1.4:43.4:1, 1.5:43.4:1, 1.6:43.4:1, 1.7:43.4:1,1.8:43.4:1, 1.9:43.4:1, 2:43.4:1, 1:43.5:1, 1:43.5:1.1, 1:43.5:1.2,1:43.5:1.3, 1:43.5:1.4, 1:43.5:1.5, 1:43.5:1.6, 1:43.5:1.7, 1:43.5:1.8,1:43.5:1.9, 1:43.5:2, 1.1:43.5:1, 1.2:43.5:1, 1.3:43.5:1, 1.4:43.5:1,1.5:43.5:1, 1.6:43.5:1, 1.7:43.5:1, 1.8:43.5:1, 1.9:43.5:1, 2:43.5:1,1:43.6:1, 1:43.6:1.1, 1:43.6:1.2, 1:43.6:1.3, 1:43.6:1.4, 1:43.6:1.5,1:43.6:1.6, 1:43.6:1.7, 1:43.6:1.8, 1:43.6:1.9, 1:43.6:2, 1.1:43.6:1,1.2:43.6:1, 1.3:43.6:1, 1.4:43.6:1, 1.5:43.6:1, 1.6:43.6:1, 1.7:43.6:1,1.8:43.6:1, 1.9:43.6:1, 2:43.6:1, 1:43.7:1, 1:43.7:1.1, 1:43.7:1.2,1:43.7:1.3, 1:43.7:1.4, 1:43.7:1.5, 1:43.7:1.6, 1:43.7:1.7, 1:43.7:1.8,1:43.7:1.9, 1:43.7:2, 1.1:43.7:1, 1.2:43.7:1, 1.3:43.7:1, 1.4:43.7:1,1.5:43.7:1, 1.6:43.7:1, 1.7:43.7:1, 1.8:43.7:1, 1.9:43.7:1, 2:43.7:1,1:43.8:1, 1:43.8:1.1, 1:43.8:1.2, 1:43.8:1.3, 1:43.8:1.4, 1:43.8:1.5,1:43.8:1.6, 1:43.8:1.7, 1:43.8:1.8, 1:43.8:1.9, 1:43.8:2, 1.1:43.8:1,1.2:43.8:1, 1.3:43.8:1, 1.4:43.8:1, 1.5:43.8:1, 1.6:43.8:1, 1.7:43.8:1,1.8:43.8:1, 1.9:43.8:1, 2:43.8:1, 1:43.9:1, 1:43.9:1.1, 1:43.9:1.2,1:43.9:1.3, 1:43.9:1.4, 1:43.9:1.5, 1:43.9:1.6, 1:43.9:1.7, 1:43.9:1.8,1:43.9:1.9, 1:43.9:2, 1.1:43.9:1, 1.2:43.9:1, 1.3:43.9:1, 1.4:43.9:1,1.5:43.9:1, 1.6:43.9:1, 1.7:43.9:1, 1.8:43.9:1, 1.9:43.9:1, 2:43.9:1,1:44:1, 1:44:1.1, 1:44:1.2, 1:44:1.3, 1:44:1.4, 1:44:1.5, 1:44:1.6,1:44:1.7, 1:44:1.8, 1:44:1.9, 1:44:2, 1.1:44:1, 1.2:44:1, 1.3:44:1,1.4:44:1, 1.5:44:1, 1.6:44:1, 1.7:44:1, 1.8:44:1, 1.9:44:1, 2:44:1,1:45:1, 1:45:1.1, 1:45:1.2, 1:45:1.3, 1:45:1.4, 1:45:1.5, 1:45:1.6,1:45:1.7, 1:45:1.8, 1:45:1.9, 1:45:2, 1.1:45:1, 1.2:45:1, 1.3:45:1,1.4:45:1, 1.5:45:1, 1.6:45:1, 1.7:45:1, 1.8:45:1, 1.9:45:1, or 2:45:1.For example, in one embodiment, the ratio of amounts for each activeagent is (1): (43.33):(1.67) for hydrocodone, acetaminophen andpromethazine, respectively.

In another embodiment, the pharmaceutical composition comprisesoxycodone, a pharmaceutically acceptable salt or its thiosemicarbazone,p-nitrophenylhydrazone, o-methyloxime, semicarbazone, orbis(methylcarbamate) (each of the foregoing being a hydrocodone agent orderivative); acetaminophen; and promethazine. Furthermore the oxycodoneagent is present in a range of about 1 mg to about 200 mg, including butnot limited to 1.0 mg, 1.5 mg, 2.5 mg, 3.0 mg, 4.0 mg, 4.5 mg, 5.0 mg,5.5 mg, 6.0 mg, 6.5 mg, 7.0 mg, 7.5 mg, 8.0 mg, 8.5 mg, 9.0 mg, 9.5 mg,10.0, 10.5 mg, 11.0 mg, 12.0 mg, 12.5 mg, 13.0 mg, 13.5 mg, 14.0 mg,14.5 mg, 15.0 mg, 15.5 mg, 16 mg, 16.5 mg, 17 mg, 17.5 mg, 18 mg, 18.5mg, 19 mg, 19.5 mg or 20 mg, 30 mg, 40 mg, 50 mg, 70 mg, 100 mg, 130 mg,160, 190 mg, 200 mg. Furthermore, the acetaminophen is in a range ofbetween about 200 mg to about 600 mg, including but not limited to 200mg, 225 mg, 250 mg, 275 mg, 300 mg, 325 mg, 350 mg, 375 mg, 400 mg, 425mg, 450 mg, 475 mg, 500 mg, 525 mg, 550 mg, 575 mg, 600 mg, and apreferred range of about 325 mg. The pharmaceutical composition furthercomprises between about 0.5 mg to about 60 mg of an antihistamine (e.g.,promethazine), including but not limited to 0.5 mg, 1.0 mg, 1.5 mg, 2.0mg, 2.5 mg, 3.0 mg, 3.5 mg, 4.0 mg, 4.5 mg, 5.0 mg, 5.5 mg, 6.0 mg, 6.5mg, 7.0 mg, 7.5 mg, 8.0 mg, 8.5 mg, 9.0 mg, 9.5 mg, 10 mg, 10.5 mg, 11.0mg, 11.5 mg, 12.0 mg, 12.5 mg, 15 mg, 20 mg, 30 mg, 40 mg, 50 mg, or 60mg.

In one embodiment, the pharmaceutical composition provides promethazineat 12.5 mg. In one embodiment, a composition of the invention comprisesoxycodone, acetaminophen and promethazine, wherein the compositioncomprises the agents in a ratio of about (1 to 2): (40 to 45):(1 to 2),respectively. For example, in one embodiment, the ratio of amounts foreach active agent is (1): (43.33):(1.67) for oxycodone, acetaminophenand promethazine, respectively. In one embodiment, a pharmaceuticalcomposition of the invention comprises an antihistamine (e.g.,promethazine) at a lower dosage than that which the antihistamine isadministered alone. For example, the antihistamine is provided in thecomposition at a dosage to prevent sedation, which may be observed withrelatively higher dosages of promethazine. Thus in some embodiments,promethazine is provided at 1, 2, 3, 4, 5, 5.5., 6, 6.5, 7, 7.5, 8, 8.5,9, 9.5, 10, 10.5, 11, 11.5, 12, 12.5, 13, 13.5, 14, 14.5, 15, 15.5, 16,16.5, 17, 17.5, 18, 18.5, 19, 19.5, 20, 20.5, 21, 21.5, 22, 22.5, 23,23.5, 24, 24.5, 25, 25.5, 26, 26.5, 27, 27.5, 28, 28.5, 29, 29.5, 30,30.5, 31, 31.5, 32, 33, 33.5, 34, 34.5, 35, 36, 36.5, 37, 37.5, 38,38.5, 39, 39.5, 40, 40.5, 41, 41.5, 42, 42.5, 43, 43.5, 44, 44.5, 45,45.5, 46, 46.5, 47, 47.5, 48, 48.5, 49, 49.5 or 50. Therefore, anantihistamine or antiemetic (e.g., promethazine) can be provided at adosage that is effective in reducing adverse affects associated with theopioid analgesic and/or non-opioid analgesic, but is at a relative lowenough dosage (e.g., given the subject's weight) to prevent sedationassociated with the antihistamine/antiemetic. Examples of adverseeffects include acute liver toxicity, allergic reactions such asswelling, difficulty breathing, closing of throat, abdominal pain,nausea, unusual bleeding or bruising.

In one embodiment, a pharmaceutical composition of the inventioncomprises 6-8 mg of hydrocodone (such as about 6.0 mg, 6.1 mg, 6.2 mg,6.3 mg, 6.4 mg, 6.5 mg, 6.6 mg, 6.7 mg, 6.8 mg, 6.9 mg, 7.0 mg, 7.1 mg,7.2 mg, 7.3 mg, 7.4 mg, 7.5 mg, 7.6 mg, 7.7 mg, 7.8 mg, 7.9 mg, or 8.0mg,), 310-330 mg of acetaminophen (such as about 310 mg, 315 mg, 320 mg,or 325 mg), and 5-13 mg of promethazine (such as about 10 mg, 10.5 mg,11.0 mg, 11.5 mg, 12.0 mg, 12.5 mg, 13.0, mg, 13.5 mg, 14.0 mg, 14.5 mg,or 15 mg). The hydrocodone and the acetaminophen can be formulated usingconventional technologies to provide for an extended time release over adesired dosage interval. All or some of the promethazine is formulatedfor immediate release to help abate common adverse effects associatedwith the hydrocodone and/or acetaminophen including nausea, vomiting,other gastric upsets, skin rashes, allergic reactions such as swelling,difficulty breathing, closing of throat, abdominal pain, unusualbleeding or bruising.

In one embodiment, a composition of the invention comprises from 1% to20% by weight of an antihistamine (such as 1%, 1.5%, 2%, 2.5%, 3%, 3.5%,4%, 4.5%, 5%, 5.5%, 6%, 6.5%, 7%, 7.5%, 8%, 8.5%, 9%, 9.5%, 10%, 10.5%,11%, 11.5%, 12%, 12.5%, 13%, 13.5%, 14%, 14.5%, 15%, 15.5%, 16%, 16.5%,17%, 17.5%, 18%, 18.5%, 19%, 19.5%, or 20%); from 10% to 80% by weight anon-opioid analgesic (such as 10%, 10.5%, 11%, 11.5%, 12%, 12.5%, 13%,13.5%, 14%, 14.5%, 15%, 15.5%, 16%, 16.5%, 17%, 17.5%, 18%, 18.5%, 19%,19.5%, 20%, 20.5%, 21%, 21.5%, 22%, 22.5%, 23%, 23.5%, 24%, 24.5%, 25%,25.5%, 26%, 26.5%, 27%, 27.5%, 28%, 28.5%, 29%, 29.5%, 30%, 30.5%, 31%,31.5%, 32%, 32.5%, 33%, 33.5%, 34%, 34.5%, 35%, 35.5%, 36%, 36.5%, 37%,37.5%, 38%, 38.5%, 39%, 39.5%, 40%, 40.5%, 41%, 41.5%, 42%, 42.5%, 43%,43.5%, 44%, 44.5%, 45%, 45.5%, 46%, 46.5%, 47%, 47.5%, 48%, 48.5%, 49%,49.5%, 50%, 50.5%, 51%, 51.5%, 52%, 52.5%, 53%, 53.5%, 54%, 54.5%, 55%,55.5%, 56%, 56.5%, 57%, 57.5%, 58%, 58.5%, 59%, 59.5%, 60%, 60.5%, 61%,61.5%, 62%, 62.5%, 63%, 63.5%, 64%, 64.5%, 65%, 65.5%, 66%, 66.5%, 67%,67.5%, 68%, 68.5%, 69%, 69.5%, 70%, 70.5%, 71%, 71.5%, 72%, 72.5%, 73%,73.5%, 74%, 74.5%, 75%, 75.5%, 76%, 76.5%, 77%, 77.5%, 78%, 78.5%, 79%,79.5%, 80%); and from 1% to 20% by weight of an opioid analgesic (suchas 1%, 1.5%, 2%, 2.5%, 3%, 3.5%, 4%, 4.5%, 5%, 5.5%, 6%, 6.5%, 7%, 7.5%,8%, 8.5%, 9%, 9.5%, 10%, 10.5%, 11%, 11.5%, 12%, 12.5%, 13%, 13.5%, 14%,14.5%, 15%, 15.5%, 16%, 16.5%, 17%, 17.5%, 18%, 18.5%, 19%, 19.5%, or20%).

In one embodiment, a composition of the invention comprises 6-8 mg ofoxycodone HCl (such as about 7.5 mg), 310-330 mg of acetaminophen (suchas about 325 mg), and 6-8 mg of promethazine (such as about 12.5 mg).The oxycodone HCl and the acetaminophen can be formulated usingconventional technologies to provide for an extended time release over adesired dosage interval. All or some of the promethazine is formulatedfor immediate release. Therefore, in one embodiment, administration of acomposition of the invention comprising such a promethazine active agentcan result in reduced, abated or eliminated adverse effects associatedwith the oxycodone HCl and/or acetaminophen. Reduced, abated oreliminated adverse effects include but are not limited to includingnausea, vomiting, other gastric upsets, skin rashes, allergic reactionssuch as swelling, difficulty breathing, closing of throat, abdominalpain, unusual bleeding or bruising or any combination thereof.

The dosages and concentrations of active agents in the compositions maybe varied as desired, as further described herein. Depending on thesubject and/or condition being treated and on the administration route,the active agent in a composition can generally be administered indosages of 0.01 mg to 500 mg V/kg body weight per day, e.g. about 20mg/day for an average person. The dosage can be adjusted based on themode of administration. A typical dosage may be one administration dailyor multiple administrations daily.

Of course for prolonged or controlled-release dosage forms (e.g.,patches) the unit dose is designed for administration over a definedperiod of time. In some embodiments, dosage for one or a combination ofagents can be from 0.01 to 5 mg, 1 to 10 mg, 5 to 20 mg, 10 to 50 mg, 20to 100 mg, 50 to 150 mg, 100 to 250 mg, 150 to 300 mg, 250 to 500 mg,300 to 600 mg or 500 to 1000 mg V/kg body weight. Dose levels can varyas a function of the specific compound, the severity of the symptoms andthe susceptibility of the subject to adverse effects.

Routes of Administration

In various embodiments of the present invention, the active agents areformulated to be administered through oral dosage forms (e.g., tablets,capsules, gels), inhalations, nasal sprays, patches, absorbing gels,liquids, liquid tannates, suppositories, injections, I.V. drips, otherdelivery methods, or a combination thereof to treat subjects.Administration may be performed in a variety of ways, including, but notlimited to orally, subcutaneously, intravenously, intranasally,intraotically, transdermally, topically (e.g., gels, salves, lotions,creams, etc.), intraperitoneally, intramuscularly, intrapulmonary (e.g.,AERx® inhalable technology commercially available from Aradigm, orInhance, pulmonary delivery system commercially available from InhaleTherapeutics), vaginally, parenterally, rectally, or intraocularly.

To prepare the present compositions, the active agents can be mixed witha suitable pharmaceutically acceptable carrier. Upon mixing of thecompounds, the resulting composition can be a solid, a half-solid, asolution, suspension, or an emulsion. Such compositions can be preparedaccording to methods known to those skilled in the art. The forms of theresulting compositions can depend upon a variety of factors, includingthe intended mode of administration and the solubility of the compoundsin the selected carrier or vehicle. The effective concentration ofanalgesics is sufficient for lessening or alleviating pain. In oneembodiment of the invention, the components of the present compositionsare at least one opioid analgesic agent (e.g., hydrocodone/oxycodone),one non-opioid analgesic agent (e.g., acetaminophen), and oneantihistamine agent (e.g., promethazine). In other embodiments,administration comprises administration of an antihistamine (e.g.,promethazine) separately, prior to, or during administration of theanalgesic formulations described herein (e.g., which compriseshydrocodone and acetaminophen).

The agents of the compositions and methods of the present invention canbe administered by the nasal inhalation route using conventionalnebulizers or by oxygen aerosolization to provide convenient pain reliefwith reduced adverse effects. The agents can be suspended or dissolvedin a pharmacologically acceptable inhalation carrier. Examples of suchcarriers are distilled water, water/ethanol mixtures, and physiologicalsaline solution. Conventional additives including sodium chloride,glucose, citric acid and the like may be employed in these dosage formsto stabilize or to provide isotonic media. In one embodiment of theinvention, the compositions suitable for nasal inhalation by oxygenaerosolization administration comprise hydrocodone or oxycodone,acetaminophen, and promethazine. In other embodiments, an antihistamine(e.g., promethazine) can be administered separately, prior to, or duringadministration of the compositions described herein (e.g., thosecomprising hydrocodone and acetaminophen).

The agents of the present invention can also be administered as aself-propelled dosage unit in aerosol form suitable for inhalationtherapy. Suitable means for employing the aerosol inhalation therapytechnique are described, for example, in U.S. Pat. No. 6,913,768 toCouch et al., incorporated herein by reference in its entirety. Theagent can be suspended in an inert propellant such as a mixture ofdichlorodifluoromethane and dichlorotetrafluoroethane, together with aco-solvent such as ethanol, together with other medications such asalbuterol, together with flavoring materials and stabilizers. In oneembodiment of the invention, the agents useful for a self-propelleddosage unit in aerosol form administration are hydrocodone or oxycodone,acetaminophen, and promethazine.

The agents of the compositions and methods of the present invention canalso be administered as nasal spray/drop compositions, which canconveniently and safely be applied to subjects to effectively treat painwith reduced adverse effects. The compositions may further comprise awater soluble polymer such as polyvinylpyrrolidone, together with othermedications such as sumatriptan, together with bioadhesive material. Inone embodiment of the invention, the components of a composition fornasal spray or drop administration are hydrocodone or oxycodone agent,acetaminophen, and promethazine.

The compositions of the present invention can also be administeredtopically to the skin of a subject. The agents can be mixed with apharmaceutically acceptable carrier or a base which is suitable fortopical application to skin to form a dermatological composition.Suitable examples of carrier or base include, but not limited to, water,glycols, alcohols, lotions, creams, gels, emulsions, and sprays. Adermatological composition comprising an analgesic agent can beintegrated into a topical dressing, medicated tape, dermal patchabsorbing gel and cleansing tissues. In one embodiment of the invention,the dermatological composition comprises hydrocodone or oxycodone,acetaminophen, and promethazine.

The compositions of the present invention can also be in liquid orliquid tannate form. The liquid formulations can comprise, for example,an agent in water-in-solution and/or suspension form; and a vehiclecomprising polyethoxylated castor oil, alcohol and/or a polyoxyethylatedsorbitan mono-oleate with or without flavoring. Each dosage formcomprises an effective amount of an active agent and can optionallycomprise pharmaceutically inert agents, such as conventional excipients,vehicles, fillers, binders, disintegrants, solvents, solubilizingagents, sweeteners, coloring agents and any other inactive agents thatcan be included in pharmaceutical dosage forms for oral administration.Examples of such vehicles and additives can be found in Remington'sPharmaceutical Sciences, 17th edition (1985). Therefore, in oneembodiment a liquid composition of the invention comprises an opioidanalgesic (e.g., hydrocodone or oxycodone), a non-opioid analgesic(e.g., acetaminophen) and an antihistamine (e.g., promethazine).

The compositions of the present invention can also be administered in asuppository form, comprising an outer layer containing the compositionin a suppository base. The suppository base may, for example, be anyconventional suppository base material such as glycogelatin,polyethylene glycol, fractionated palm kernel oil, or one or morenatural, synthetic or semisynthetic hard fats such as cocoa butter.Therefore, in one embodiment of the invention, the base material ismixed with an opioid analgesic (e.g., hydrocodone/oxycodone), anon-opioid analgesic (e.g., acetaminophen) and an antihistamine (e.g.,promethazine).

The compositions of the present invention can also be administered ininjection-ready stable liquids for injection or I.V. drip. For example,saline or other injection-ready liquid can be mixed with an opioidanalgesic (e.g., hydrocodone or oxycodone), a non-opioid analgesic(e.g., acetaminophen) and an antihistamine (e.g., promethazine).

Dosage Forms

In various embodiments of the invention, a composition is in one or moredosage form. For example, a composition can be administered in a solidor liquid form. Examples of solid dosage forms include but are notlimited to discrete units in capsules or tablets, as a powder orgranule, or present in a tablet conventionally formed by compressionmolding. Such compressed tablets may be prepared by compressing in asuitable machine the three or more agents and a pharmaceuticallyacceptable carrier. The molded tablets can be optionally coated orscored, having indicia inscribed thereon and can be so formulated as tocause immediate, substantially immediate, slow, or controlled release ofthe hydrocodone and/or the acetaminophen. Furthermore, dosage forms ofthe invention can comprise acceptable carriers or salts known in theart, such as those described in the Handbook of PharmaceuticalExcipients, American Pharmaceutical Association (1986), incorporated byreference herein.

In one embodiment, the components are mixed with a pharmaceuticalexcipient to form a solid preformulation composition comprising ahomogeneous mixture of compounds of the present invention. Whenreferring to these compositions as “homogeneous”, it is meant that theagents are dispersed evenly throughout the composition so that thecomposition can be subdivided into unit dosage forms such as tablets orcapsules. This solid preformulation composition can then subdivided intounit dosage forms of the type described above comprising from, forexample, about 1.0 mg to about 15 mg of an opioid, such as hydrocodoneor oxycodone of the present invention.

The compositions can be formulated, in the case of capsules or tablets,to be swallowed whole, for example with water. The inclusion of theside-effect-reducing agent such as an antihistamine or antiemetic toabate common symptoms of nausea and vomiting are believed beneficial inthat promethazine or the like will eliminate or minimize the amount ofdiscomfort. Adverse effects reduced or eliminated include but are notlimited to nausea, vomiting, other gastric upsets, skin rashes, allergicreactions such as swelling, difficulty breathing, closing of throat,abdominal pain, unusual bleeding or bruising.

Frequently, subjects taking opioids have adverse effects includingvomiting that can occur shortly after taking a first or subsequent dose.As a consequence, a portion of the opioid dose is subsequently lost,making it difficult to accurately gauge replacement dosages for thesubject, and for subjects outside of a hospital or clinic environment,there might not be any alternative form of pain medication readilyavailable. As a consequence, subjects experiencing gastric discomfortsuch as vomiting will lack the beneficial effects of the opioidanalgesic and experience the additional discomfort and enhanced painassociated with vomiting. This problem is solved by also administeringpromethazine, which reduces side-effects.

The dosage forms of the present invention can be manufactured usingprocesses that are well known to those of skill in the art. For example,for the manufacture of bi-layered tablets, the agents can be disperseduniformly in one or more excipients, for example, using high sheargranulation, low shear granulation, fluid bed granulation, or byblending for direct compression. Excipients include diluents, binders,disintegrants, dispersants, lubricants, glidants, stabilizers,surfactants and colorants. Diluents, also termed “fillers”, can be usedto increase the bulk of a tablet so that a practical size is providedfor compression. Non-limiting examples of diluents include lactose,cellulose, microcrystalline cellulose, mannitol, dry starch, hydrolyzedstarches, powdered sugar, talc, sodium chloride, silicon dioxide,titanium oxide, dicalcium phosphate dihydrate, calcium sulfate, calciumcarbonate, alumina and kaolin. Binders can impart cohesive qualities toa tablet formulation and can be used to help a tablet remain intactafter compression. Non-limiting examples of suitable binders includestarch (including corn starch and pregelatinized starch), gelatin,sugars (e.g., glucose, dextrose, sucrose, lactose and sorbitol),celluloses, polyethylene glycol, waxes, natural and synthetic gums,e.g., acacia, tragacanth, sodium alginate, and synthetic polymers suchas polymethacrylates and polyvinylpyrrolidone. Lubricants can alsofacilitate tablet manufacture; non-limiting examples thereof includemagnesium stearate, calcium stearate, stearic acid, glyceryl behenate,and polyethylene glycol. Disintegrants can facilitate tabletdisintegration after administration, and non-limiting examples thereofinclude starches, alginic acid, crosslinked polymers such as, e.g.,crosslinked polyvinylpyrrolidone, croscarmellose sodium, potassium orsodium starch glycolate, clays, celluloses, starches, gums and the like.Non-limiting examples of suitable glidants include silicon dioxide, talcand the like. Stabilizers can inhibit or retard drug decompositionreactions, including oxidative reactions. Surfactants can also includeand can be anionic, cationic, amphoteric or nonionic. If desired, thetablets can also comprise nontoxic auxiliary substances such as pHbuffering agents, preservatives, e.g., antioxidants, wetting oremulsifying agents, solubilizing agents, coating agents, flavoringagents, and the like.

Extended or controlled-release formulations can comprise one or morecombination of excipients that slow the release of the agents by coatingor temporarily bonding or decreasing their solubility of the activeagents. Examples of these excipients include cellulose ethers such ashydroxypropylmethylcellulose (e.g., Methocel K4M),polyvinylacetate-based excipients such as, e.g., Kollidon SR, andpolymers and copolymers based on methacrylates and methacrylic acid suchas, e.g., Eudragit NE 30D. In one embodiment of the invention, theanalgesic agents (e.g., hydrocodone or oxycodone, and acetaminophen) areformulated for extended or controlled-release while the promethazine isformulated for immediate release. In another embodiment, all agents areformulated for extended or controlled-release.

Pharmaceutical carriers or vehicles suitable for administration of thecompounds provided herein include all such carriers known to thoseskilled in the art to be suitable for the particular mode ofadministration. In addition, the analgesics and promethazine can also beadministered with other components that do not impair the desiredaction, or with components that supplement the desired action, or haveanother action. As noted above, a composition can comprise additional(e.g., a fourth, fifth, sixth, etc.) addition active compounds.

In one embodiment of the present invention, the composition comprisesthree or more active agents wherein at least one active agent is inimmediate release form. In this embodiment the immediate-release form isincluded in an amount that is effective to shorten the time to itsmaximum concentration in the blood. By way of example, certainimmediate-release pharmaceutical preparations are taught in UnitedStates Patent Publication US 2005/0147710A1 entitled, “Powder Compactionand Enrobing” which is incorporated herein in its entirety by reference.

In a further embodiment of the present invention, the component inimmediate-release form is a component that reduces abates or eliminatesand/or suppresses an adverse effect associated with one or more opioidanalgesics.

For example, the immediate-release active agent can be an antihistamineor antiemetic, which reduces, abates or eliminates an adverse effectassociated with opioid and/or non-opioid analgesics described herein.Thus, in one embodiment, of the invention, the analgesic formulationcomprises an opioid and non-opioid analgesic (e.g., hydrocodone oroxycodone and acetaminophen, respectively) and an antihistamine (e.g.,promethazine).

In a further embodiment of the present invention, all or less than allof the total amount of the antiemetic or antihistamine agent isformulated in immediate-release form, as described herein.

A variety of known methods and materials may be used to bring about theimmediate release. For instance, placement of the agent along anexterior of a tablet (e.g., coating the exterior or formulating theouter layer with the agent) and/or combined with forming a tablet bycompressing the powder using low compaction can produceimmediate-release of the agent from the composition.

In a specific embodiment, an effective amount of the promethazine inimmediate-release form may be coated onto a substrate. For example,where the extended release of one or more analgesics from a formulationis due to a controlled-release coating, an immediate-release layercomprising promethazine can overcoat the controlled-release coating. Onthe other hand, the immediate-release layer of promethazine can becoated onto the surface of a substrate wherein hydrocodone and/oroxycodone is incorporated in a controlled release matrix. Where aplurality of controlled-release substrates comprising an effective unitdose of an analgesic (e.g., multiparticulate systems including pellets,spheres, beads and the like) are incorporated into a hard gelatincapsule, the side-effect-reducing compound can be incorporated into thegelatin capsule via inclusion of an amount of immediate-releasepromethazine as a powder or granulate within the capsule. Alternatively,the gelatin capsule itself can be coated with an immediate-release layerof promethazine. One skilled in the art recognizes still otheralternative means of incorporating the immediate releaseside-effect-reducing compound into the unit dose. By including aneffective amount of immediate-release side-effect-reducing compound suchas promethazine in the unit dose, the experience of adverse effectsincluding nausea, vomiting, other gastric upsets, skin rashes, allergicreactions such as swelling, difficulty breathing, closing of throat,abdominal pain, unusual bleeding or bruising and skin rashes in subjectscan be significantly reduced.

In one embodiment of the present invention, the composition comprisesthree or more active agents wherein at least one active agent is incontrolled-release form. The controlled-release form can be in an amountthat is effective to protect the agent from rapid elimination from thebody. Certain preparations relating to the controlled release of apharmaceutical are taught in United States Patent Publication US2005/0147710A1 entitled, “Powder Compaction and Enrobing” which isincorporated herein in its entirety by reference.

In a further embodiment of the present invention, the agent incontrolled-release form is an opioid analgesic such as, for example,hydrocodone, or oxycodone. In one embodiment of the invention,compositions comprise one or more carriers that protect the agentsagainst rapid elimination from the body, such as time-releaseformulations or coatings. Such carriers include controlled-releaseformulations, including, for example, microencapsulated deliverysystems. The active agents can be included in the pharmaceuticallyacceptable carrier in amounts sufficient to treat a subject's pain, withreduced adverse effects.

In certain embodiments the compositions are in oral-dosage form andcomprise a matrix that includes, for example, a controlled-releasematerial and an analgesic such as hydrocodone or a pharmaceuticallyacceptable salt thereof. In certain embodiments, the matrix iscompressible into a tablet and can be optionally overcoated with acoating that can control the release of the analgesics includinghydrocodone or pharmaceutically acceptable salt thereof from thecomposition. In this embodiment blood levels of analgesics aremaintained within a therapeutic range over an extended period of time.In certain alternate embodiments, the matrix is encapsulated.

Tablets or capsules containing a composition of the present inventioncan be coated or otherwise compounded to provide a dosage form affordingthe advantage of prolonged action. For example, the tablet or capsulecan contain an inner dosage and an outer dosage component, the latterbeing in the form of an envelope over the former. The two components canbe separated by an enteric layer that serves to resist disintegration inthe stomach and permit the inner component to pass intact into theduodenum or to be delayed in release. For controlled extended release,the capsule can also have micro drilled holes.

A coating comprising a side-effect-reducing compound such aspromethazine, in immediate release form, can be added to the outside ofa controlled-release tablet core to produce a final dosage form. Such acoating can be prepared by admixing a compound like promethazine withpolyvinylpyrrolidone (PVP) 29/32 or hydroxypropyl methylcellulose (HPMC)and water/isopropyl alcohol and triethyl acetate. Such animmediate-release coating can be spray coated onto the tablet cores. Theimmediate-release coating can also be applied using a press-coatingprocess with a blend consisting of 80% by weight promethazine and 20% byweight of lactose and hydroxypropyl methylcellulose type 2910.Press-coating techniques are known in the art and are described in U.S.Pat. No. 6,372,254 to Ting et al., incorporated herein by reference inits entirety.

The immediate-release or controlled-release dosage forms of the presentinvention can also take the form of a bi-layered tablet, which comprisesa first layer and a second layer. The first layer comprises a first drugselected from analgesics, antitussives, antihistamines, antiemetics. Thesecond layer comprises a second drug selected from analgesics,antitussives, antihistamines, antiemetics. The second drug is the sameas or different from the first drug. The bi-layered tablet can provide aplasma concentration within the therapeutic range of the second drugover a period which is coextensive with at least about 70% of the period(e.g., 12 hours) within which the bi-layered tablet provides a plasmaconcentration within the therapeutic range of the first drug.

In a further aspect of the bi-layered tablet, the first layer is animmediate release layer and/or the second layer is a controlled-releaselayer.

In one aspect of the bi-layered tablet of the present invention, bothlayers can comprise an opioid analgesic such as hydrocodone oroxycodone; a non-opioid analgesic such as acetaminophen; and a compound,such as promethazine, to reduce or suppress adverse effects.

In a further aspect of the bi-layered tablet of the present invention,the first layer comprises promethazine and the second layer compriseshydrocodone or oxycodone. The first or second layer can further compriseacetaminophen.

In one embodiment of the present invention, the components are releasedfrom a multi-layered tablet that comprises a first layer and a secondlayer. In this embodiment the first layer comprises a first drug whichis selected from analgesics, antitussives, antihistamines, antiemetics.The second layer comprises a second drug which is selected fromanalgesics, antitussives, antihistamines, antiemetics. The second drugcan be the same as or different from the first drug. In one aspect ofthe multi-layered tablet, the second drug can have a plasma half-lifethat differs from the plasma half-life of the first drug by at leastabout 2 hours.

In a further aspect of the multi-layered tablet, the first layer is animmediate-release layer and/or the second layer is a controlled releaselayer.

In one embodiment of the multi-layered tablet of the present invention,both the first layer and the second layer can comprise an opioidanalgesic such as hydrocodone or oxycodone; a non-opioid analgesic suchas acetaminophen; and compound to reduce or suppress adverse effectssuch as promethazine.

In a further embodiment of the multi-layered tablet of the presentinvention, the first layer comprises promethazine and the second layercomprises hydrocodone or oxycodone. The first or second layer canfurther comprise acetaminophen.

The immediate-release or controlled release dosage forms of the presentinvention can also take the form of pharmaceutical particlesmanufactured by a variety of methods, including but not limited tohigh-pressure homogenization, wet or dry ball milling, or small particleprecipitation (nGimat's NanoSpray^(SM)). Other methods to make asuitable powder formulation are the preparation of a solution of activeingredients and excipients, followed by precipitation, filtration, andpulverization, or followed by removal of the solvent by freeze-drying,followed by pulverization of the powder to the desired particle size. Inone embodiment the pharmaceutical particles are manufactured to a finalsize of 3-1000 uM, such as at most 3, 4, 5, 6, 7, 8, 9,10, 20, 30, 40,50, 60, 70, 80, 90, 100, 150, 200, 250, 300, 350, 400, 450, 500, 550,600, 650, 700, 750, 800, 850, 900, 950, 1000 uM. In another embodimentthe pharmaceutical particles are manufactured to a final size of 10-500uM. In some embodiments, the pharmaceutical particles are manufacturedto a final size of 50-600 uM. In some embodiments, the pharmaceuticalparticles are manufactured to a final size of 100-800 uM. These dosageforms can include immediate-release particles in combination withcontrolled-release particles in a ratio sufficient useful for deliveringthe desired dosages of active agents. For example, the immediate-releaseparticles can comprise about 12.5 mg of promethazine, and thecontrolled-release particles can comprise about 7.5 mg of hydrocodone(or 7.5 mg of oxycodone) and about 325 mg of acetaminophen.

In another aspect of the present invention, the components are releasedfrom a multi-layered tablet that comprises at least a first layer, asecond layer and a third layer. Wherein, the layers containing an agent(such as an opioid analgesic, a non-opioid analgesic and anantihistamine) can be optionally separated by one or more layers ofinert materials. In one embodiment the layers containing an agent havesimilar rates of release, e.g. all are immediate release or all arecontrolled-release. In an alternative embodiment the layers havedifferent rates of release. In this aspect at least one layer is animmediate release layer and at least one layer is a controlled releaselayer. For example in one embodiment the multilayer tablet comprises atleast three layers, each of which contains a different agent, such as:layer one contains promethazine; layer two comprises hydrocodone oroxycodone; and layer three comprises acetaminophen. In this embodimentthe promethazine layer may be designed for immediate-release, while theother two layers may be designed for controlled-release.

In another embodiment a composition comprising an opioid analgesicagent, a non-opioid analgesic agent and an antihistamine agent isadministered to a subject. In this embodiment the antihistaminecomponent can be formulated for immediate release or a controlledrelease which is faster than the release of the opioid analgesic agentand, optionally, the non-opioid analgesic agent. In one embodiment thecomposition comprises hydrocodone or oxycodone, acetaminophen andpromethazine.

In another embodiment a composition comprising an opioid analgesicagent, a non-opioid analgesic agent and an antihistamine agent isadministered to a subject; wherein the amounts and release rates of theopioid analgesic agent and the antihistamine agent are effective toreduce at least one side affect of opioid treatment in a subject. In oneembodiment the composition comprises hydrocodone or oxycodone,acetaminophen and promethazine.

Additives

The present compositions can further comprise suitable additives,including, but not limited to, diluents, binders, surfactants,lubricants, glidants, coating materials, plasticizers, coloring agents,flavoring agents, or pharmaceutically inert materials. Examples ofdiluents include, for example, cellulose; cellulose derivatives such asmicrocrystalline cellulose and the like; starch; starch derivatives suchas corn starch, cyclodextrin and the like; sugar; sugar alcohol such aslactose, D-mannitol and the like; inorganic diluents such as driedaluminum hydroxide gel, precipitated calcium carbonate, magnesiumaluminometasilicate, dibasic calcium phosphate and the like.

Examples of binders include, for example, hydroxypropylcellulose,methylcellulose, hydroxypropylmethylcellulose, povidone, dextrin,pullulane, hydroxypropyl starch, polyvinyl alcohol, scacia, agar,gelatin, tragacanth, macrogol and the like.

Examples of surfactants include, for example, sucrose esters of fattyacids, polyoxyl stearate, polyoxyethylene hydrogenated castor oil,polyoxyethylene polyoxypropylene glycol, sorbitan sesquioleate, sorbitantrioleate, sorbitan monostearate, sorbitan monopalmitate, sorbitanmonolaurate, polysorbate, glyceryl monostearate, sodium lauryl sulfate,lauromacrogol and the like.

Examples of lubricants include, for example, stearic acid, calciumstearate, magnesium stearate, talc and the like.

Examples of glidants include, for example, dried aluminium hydroxidegel, magnesium silicate and the like.

Examples of coating materials include, for example, hydroxypropylmethylcellulose 2910, aminoalkyl methacrylate copolymer E, polyvinylacetaldiethylaminoacetate, macrogol 6000, titanium oxide and the like.Examples of plasticizers include, for example, triethyl citrate,triacetin, macrogol 6000 and the like.

EXAMPLES

Examples of Hydrocodone-Acetaminophen-Promethazine-Containing Analgesics

Example 1

Analgesic Composition A Agents mg/Tablet Hydrocodone Bitartrate 7.5 mgAcetaminophen 325 mg Promethazine 12.5 mg

Example 2

The composition of Example 1 is orally administered with water to asubject having a tendency to exhibit adverse effects of gastric upset,nausea, vomiting, or skin rash. Such subjects, upon taking thecomposition set forth in Example 1 would receive a therapeuticallyeffective amount of promethazine in their blood stream. The promethazinewould reduce the adverse effects that such a target population wouldotherwise exhibit.

In another example, the dosage form is a bi-layered tablet, in which thefirst layer is an immediate-release layer comprising 12.5 mg ofpromethazine hydrochloride and the second layer is a controlled-releaselayer comprising 12.5 mg of promethazine hydrochloride, 15 mg ofhydrocodone bitartrate, and 325 mg of acetaminophen.

Examples of Oxycodone Hydrochloride, Acetaminophen, Promethazinecontaining Analgesics

Example 3

Analgesic Composition B Agents mg/Tablet Oxycodone HCl 7.5 mg or 5 mgAcetaminophen 325 mg Promethazine 12.5 mg

Example 4

The composition of Example 3 is orally administered with water to asubject having a tendency to exhibit adverse effects of gastric upset,nausea, vomiting, or skin rash. Such subjects, upon taking thecomposition set forth in Example 3 would receive a therapeuticallyeffective amount of promethazine which will reduce the adverse effectsthat such a target population would otherwise exhibit.

In one embodiment, the dosage form is a bi-layered tablet, in which thefirst layer is an immediate-release layer comprising 12.5 mg ofpromethazine hydrochloride, and the second layer is a controlled-releaselayer comprising 12.5 mg of promethazine hydrochloride, 15 mg ofoxycodone HCl, and 325 mg of acetaminophen.

What is claimed is:
 1. A liquid pharmaceutical composition, wherein theliquid pharmaceutical composition comprises: a. hydrocodone or apharmaceutically acceptable salt thereof that is present in an effectiveamount as an antitussive; b. promethazine or a pharmaceuticallyacceptable salt thereof that is present in an effective amount as anantihistamine; and c. at least one pharmaceutically acceptableexcipient.
 2. The liquid pharmaceutical composition of claim 1, whereinthe at least one pharmaceutically acceptable excipient comprises citricacid or sorbitol.
 3. The liquid pharmaceutical composition of claim 1,wherein the liquid pharmaceutical composition further comprises anopioid antagonist or an agent for reducing abuse and/or diversion. 4.The liquid pharmaceutical composition of claim 1, wherein the liquidpharmaceutical composition further comprises a flavoring agent.
 5. Theliquid pharmaceutical composition of claim 1, wherein thepharmaceutically acceptable salt of the hydrocodone is hydrocodonebitartrate.
 6. The liquid pharmaceutical composition of claim 1, whereinthe pharmaceutically acceptable salt of promethazine is promethazinehydrochloride.
 7. The liquid pharmaceutical composition of claim 1,wherein the hydrocodone or the pharmaceutically acceptable salt thereofis present in an amount of about 0.5 to about 30 mg.
 8. The liquidpharmaceutical composition of claim 1, wherein the hydrocodone or thepharmaceutically acceptable salt thereof is present in an amount ofabout 2.5, 5, 7.5, 10, 15, 20, 25, or 30 mg.
 9. The liquidpharmaceutical composition of claim 1, wherein the promethazine or thepharmaceutically acceptable salt thereof is present in an amount ofabout 0.5 mg, 1.0 mg, 1.5 mg, 2.0 mg, 2.5 mg, 3.0 mg, 3.5 mg, 4.0 mg,4.5 mg, 5.0 mg, 5.5 mg, 6.0 mg, 6.5 mg, 7.0 mg, 7.5 mg, 8.0 mg, 8.5 mg,9.0 mg, 9.5 mg, 10 mg, 10.5 mg, 11 mg, 11.5 mg, 12.0 mg, 12.5 mg, 13.0mg, 13.5 mg, 14.0 mg, 14.5 mg, 15.0 mg, 15.5 mg, 16 mg, 16.5 mg, 17 mg,17.5 mg, 18 mg, 18.5 mg, 19 mg, 19.5 mg or 20 mg, or 25 mg.
 10. Theliquid pharmaceutical composition of claim 1, wherein the promethazineor the pharmaceutically acceptable salt thereof is present in an amountof about 12.5 mg.
 11. The liquid pharmaceutical composition of claim 1,wherein the liquid pharmaceutical composition further comprises adecongestant or expectorant.
 12. The liquid pharmaceutical compositionof claim 11, wherein the decongestant comprises phenylephrine orpseudoephedrine.
 13. The liquid pharmaceutical composition of claim 11,wherein the expectorant comprises guaifenesin.
 14. A method for treatinga cough, the method comprising administering the liquid pharmaceuticalcomposition of claim 1 to a subject in need thereof.
 15. The method ofclaim 14, wherein the administration occurs once, twice, or three timesper day.